understand that I am opting for a service that is not urgent and not medically necessary.
I also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal government health agencies recommend social distancing.
I recognize that the staff at Interlude the Salon are closely monitoring this situation and have put In place reasonable preventative measures targeted to reduce the spread of the virus. However, given the nature of the virus. I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service by means that may be out of the hands of the team at Interlude the Salon.
Accordingly, I acknowledge and assume the risk of becoming infected with COVID-19. and any variation or mutation thereof, through this elective service and I gave my express permission for the team at Interlude the Salon to proceed with the same. This consent applies to any follow up or additional services in the upcoming months.
I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and the professionals offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.
- I do NOT have a cough.
- I do NOT have a fever.
- I have NOT been around anyone exhibiting these symptoms within the past 14
- I am NOT living with anyone who is sick or quarantined because of COVID-19.
- I have been given the option to defer my service to a later date, however I
understand all the risks including those noted herein and I would like to
proceed with this service
- I have been offered a copy of this consent form.